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Background  The identification of predictors for body image distortion would be an especially important first step in targeting a vulnerable population and developing a nutrition intervention program. We aimed to investigate the prevalence of body image distortion and the factors associated with body image distortion among Korean high school students.    Methods  We selected 20,264 normal weight high school students from the 10 th  Korea Youth Risk Behavior Web-based Survey using nationally representative data in 2014. With multivariate logistic regression, we assessed the association of body image distortion with individual demographic and socio-economic factors, weight control behaviors, and mental health characteristics.    Results  The over-estimation group of body weight status, compared with the correct estimation group, was significantly more likely to be a 3 rd  year high school student [adjusted odds ratio (AOR): 1.27, 95 % confidence interval (CI): 1.16–1.39], to be female [AOR: 3.52, 95 % CI: 3.25–3.81], to employ unhealthy weight control behaviors [AOR: 1.54, 95 % CI: 1.37–1.72], and to have a sadness [AOR: 1.25, 95 % CI: 1.16–1.35] and suicidal ideation [AOR: 1.20, 95 % CI: 1.08–1.33]. The under-estimation group, compared with the correct estimation group, was significantly less likely to be female [AOR: 0.23, 95 % CI: 0.21–0.25] and to employ unhealthy weight control behaviors [AOR: 0.50, 95 % CI: 0.43–0.59] but were more likely to have a sadness [AOR: 1.12, 95 % CI: 1.03–1.21] and suicidal ideation [AOR: 1.12, 95 % CI: 1.00–1.25].    Conclusions  Not only the over-estimation but also the under-estimation of body weight is prevalent among high school students in South Korea. Body image distortion was significantly associated with sadness and suicidal ideation.    Electronic supplementary material  The online version of this article (doi:10.1186/s12889-016-2703-z) contains supplementary material, which is available to authorized users.

bmc public health

The association of body image distortion with weight control behaviors, diet behaviors, physical activity, sadness, and suicidal ideation among Korean high school students: a cross-sectional study